Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | NM | |
Y | 101YM0800X | Mental Health Counselor | NM | |
N | 101YP1600X | Pastoral Counselor | NM |
NPI | 1285134189 |
---|---|
Provider Name | Zachary B Malott |
First Address | Ruidoso, NM 88345-7068 |
Second Address | Ruidoso, NM 88345-7068 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2018 |
Last Update Date | 16/02/2018 |